Good to the Bone

USC School of Dentistry researchers publish the first case study of an accelerated procedure involving the grafting of a patient’s own bone material.

By David Peregrino

“Given a choice for grafts, nothing is better than a patient’s own tissue,” Hessam Nowzari said.

Photo/Philip Channing

Researchers at the USC School of Dentistry said they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Led by Hessam Nowzari, director of the USC Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient’s own bone material for the grafting necessary in the accelerated orthodontic surgical procedure.

The report appeared in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth.

Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as Wilckodontics.

For this case study, the USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics.

With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office.

Afterward, as the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed.

Nowzari said that his team believed it could improve the technique by using the patient’s own bone instead of the artificial or bovine graft.

“Given a choice for grafts, nothing is better than a patient’s own tissue,” Nowzari explained. “It encourages new, healthy bone formation in the grafted area. It’s very safe and eliminates the risk of any disease transmission.”

Interestingly, it was a member of Nowzari’s team, Hsuan-Chen “Glenn” Chang, who underwent the surgery presented in the case study.

Chang, a third-year periodontology resident at the school, had an overbite and crowded teeth that needed correcting. Chang was 41 years old at the time, and accelerated orthodontics seemed like a good option for a man with a busy residency schedule.

A small amount of bone was harvested from his jaw and applied in particle form over the scored bone surrounding his teeth. After the surgery, braces were used to bring his teeth into alignment.

Chang said he experienced some discomfort in the days following the surgery, but it was manageable with over-the-counter painkillers. “It was about what I would expect for this kind of procedure,” he said.

However, he added, the benefits were impressive: In eight months, Chang’s overbite and crowded teeth were a thing of the past.

“It would have taken about two years to do this with traditional orthodontics,” Chang said.

Nowzari said that surgery to accelerate the movement of teeth is not new – dentists have been doing it since the 1800s. But techniques and the science behind the surgeries have improved in recent years and are continuing to be investigated.